RESUMO
Objectives: The study aimed to evaluate the benefits of combined therapeutic strategy of multidisciplinary mechanisms in management of cases subjected to chronic hepatic insult inducing fatigue. They were co-linked to perturbations of immune, metabolic and hepatotoxic environmental stress-induced factors posed by cigarette smoking in subjects with Schistosomal hepatic fibrosis infected with hepatitis E [HEV] and/or of chronic hepatitis B [HBV] co-infection. Study Design Selected cases involved fifty cigarette smoker subjects with schistosomal hepatic fibrosis suffering from fatigue symptoms they included twenty five cases with HEV who were categorized into those with history of chronic HBV [Gr. Ia] or without [Gr. IIa] and 25 allied subjects without HEV with of either chronic HBV [Gr, IIIa] or recurrent schisosomal infection [Gr. IVa]. Control group [Gr. V] composed of 10 healthy nonsmokers were also included. The provided therapeutic regimen for 6 months had included ginko bilopa, ginsing, royal jelly, echinacea extracts and sylimarin. The subjects prior to therapy involved [Gr. Ia - Gr. IVa] and post therapeutically [Gr. Ib - Gr. IVb]
Results: Evaluated therapeutic outcome identified significant variation in perturbed biochemical parameters assessed prior to therapy. These included alterations in serum levels of cotinine, protein C, protein S. thrombin -antithrombin complex, thrombomodulin, sialic acid, c-reactive protein, interleukin 6, p-selectin, vitamin E in LDL, vitamin C, hepatocyte growth factor, lipoprotein lipase, lipoprotein a, lipid peroxidation product, asymmetric dimethylarginine [ADMA]
Conclusion: Beneficial outcome was attained by combined multi-disciplinary therapeutic strategy alleviating variable stress-induced factors perpetuating chronic fatigue in subjects with hepatic disposition induced by environmental factors
Recommendations: Environmental factors including cigarette smoking and viral hepatitis [HEV and/or HBV co-infection] imposed in subjects with schistosomal fibrosis stress-induced symptoms of fatigue which may be co-linked to hepatotoxic insult. This could be carefully targeted by combined drug therapy influencing haemostatic immune and metabolic pathways and antioxidant defense mechanisms in subjects with hepatic disposition affecting bio-energetic capacity